Rev Bras Cineantropom Hum original article

DOI: http://dx.doi.org/10.5007/1980-0037.2017v19n1p96

Fatigue and symptoms of eating disorders

in professional dancers
Fadiga e sintomas de transtornos alimentares
em bailarinos profissionais
Yasmin Cristina Feitosa Rodrigues1
Nycolle Martins Reis1
Melissa de Carvalho Souza Vieira1
Zenite Machado1
Adriana Coutinho de Azevedo Guimarães1

Abstract – The aim of this study was to make a comparison between fatigue and eating
disorders in professional dancers in Brazil. Overall, 108 Classical Ballet or Contempo-
rary Dance dancers (28.6 ± 7.7 years) (49 women and 59 men) of companies from São
Paulo, Rio de Janeiro, Minas Gerais and Rio Grande do Sul participated in this study.
The following validated instruments were used (Eating Attitudes Test; Bulimic Inventory
Test Edinburgh; Yoshitake Fatigue Questionnaire, general Information). Results: 16% of
dancers have symptoms of anorexia; 25% in the symptomatic bulimia scale and 30% in
the bulimia scale. Significant data were identified in the comparison of bulimia nervosa
scales with fatigue domains; on the symptomatic scale with drowsiness and lack of at-
tention at work domain (p = 0.015), on the severity scale with fatigue projections to the
body domain (p = 0.014), and in both scales in the impaired concentration and attention
domain (p = 0.003 and p = 0.047) and in the general fatigue score (p = 0.016). Dancers
with higher scores for difficulty in concentration and attention are 1.558 (95% CI 1.113
to 2.179) times more likely to have symptoms of bulimia. This study showed that there
is a relationship between fatigue and symptoms of bulimia.
Key words: Dancing; Eating disorders; Fatigue; Motor activity.

Resumo – Objetivou-se realizar uma comparação entre fadiga e transtornos alimentares em

bailarinos profissionais do Brasil. Participaram 108 bailarinos (49 mulheres e 59 homens), de
Ballet Clássico ou Dança Contemporânea (28,6±7,7 anos), de companhias de São Paulo, Rio
de Janeiro, Minas Gerais e Rio Grande do Sul. Utilizaram-se instrumentos validados (Teste
de Atitudes Alimentares; Bulimic Inventory Test Edinburgh; Questionário de Fadiga de Yoshi-
take; Informações gerais). Notou-se que 16% dos bailarinos possuem sintomas de transtornos
de anorexia; 25% na escala sintomática de bulimia e 30% na escala de gravidade da bulimia.
Identificou-se dados significativos na comparação das escalas da bulimia nervosa com os do-
mínios da fadiga; na escala sintomática com domínio sonolência e falta de atenção no trabalho 1 State University of Santa Catarina.
(p=0,015), na escala de gravidade com domínio projeções da fadiga ao corpo (p=0,014), e em Florianópolis, SC. Brazil.
ambas as escalas no domínio dificuldade de concentração e atenção (p=0,003 e p=0,047) e no
escore de fadiga geral (p=0,016). Bailarinos com maiores escores para dificuldade de concentração Received: 18 July 2016
Accepted: 11 January 2017
e atenção possuem 1,558 (IC95%=1,113–2,179) vezes mais chances de apresentarem sintomas
de bulimia. Conclui-se neste estudo, que há relação entre fadiga e sintomas de bulimia nervosa. Licença
Palavras-chave: Atividade motora; Dança; Fadiga; Transtornos alimentares. BY Creative Commom
INTRODUCTION
Professional dancers can be found in all types of dance, with a greater ap-
proach in Brazil in classical ballet and contemporary dance. Classical ballet
has a rigid didactics, aiming at training with greater body requirement
with emphasis on support, balance and ballet shoes1. In this modality, body
leanness and aesthetics are valued, inducing the search for the ideal body2,
even without scientific records of the need to be skinny for the practice1.
In contemporary dance, dancers also suffer pressure on their bodies.
This modality incorporates new unconventional ballet movements or
modern dance techniques. It demands sensorial stimuli and propriocep-
tion of dancers, but it also imposes high level of rehearsal and dedication
as in classical ballet3.
In both modalities, dancers are submitted to a routine of rehears-
als, tours, elaboration of new choreographies, physical preparation, daily
training and presentations that are extremely exhaustive1,4. Due to the
high level of demand on their bodies, it is common to increase even more
the training level, with the intention of burning more calories, harming
their health by using inadequate and dangerous ways to achieve the body
of dreams. Even with thin bodies, professional dancers tend to restrict
their energy consumption 2, leading to eating disorders such as anorexia
and bulimia nervosa 5,6.
Anorexia nervosa is characterized by food restriction, leading to body
weight below the minimum expected, morbid fear of getting fat, body im-
age distortion and use of drugs for weight loss; bulimia nervosa presents
symptoms such as: recurrent episodes of binge eating, use of compensatory
behaviors in order to prevent weight gain such as inducing vomiting after
an episode of overeating and / or excessive physical activity7.
Due to the intense training of classical ballet and contemporary dance,
the appearance of trauma is frequent, with muscle fatigue being one of the
main factors that lead to the onset of injuries4,8. Fatigue has been included
in studies because it impairs the performance of different types of popula-
tions, such as athletes9 and workers10, causing impairment to quality of life11.
Due to the great amount of physical exercise performed by professional
dancers especially when spectacles approach, fatigue can cause impairment
in the performance of dancers4, for example decreased flexibility12. Eating
disorders are also associated with the performance of dancers, inappropriate
eating behaviors have been used to optimize performance, since in these
dance modalities, which favor leanness, thin body is associated with higher
athletic performance5. However, despite the influence that eating disorder
and fatigue have on performance, there is a gap in literature relating these
two variables in the same study.
Thus, it is necessary to investigate a possible relation between eating
disorders and the level of fatigue in dancers, since these factors are common
in the routine of dancers and scientific production on the subject is scarce.
This study aims to compare fatigue and symptoms of eating disorders in

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Eating disorders in professional dancers Rodrigues et al.

professional dancers in Brazil and will help to develop strategies that help
choreographers, dancers and family members to avoid the development of
fatigue and eating disorders.

METHODOLOGICAL PROCEDURES
This is a descriptive cross-sectional study based on secondary data from a
research entitled of “Professional classical ballet and contemporary dance
dancers: relationship between eating disorders and associated factors”. The
non-probabilistic sample was composed of 108 professional dancers, 49
women (29.4 ± 7.8 years) and 59 men (27.9 ± 7.6 years), of these 37 of classi-
cal ballet and 71 of contemporary dance, with mean age of 28.6 ± 7.7 years.
As inclusion criteria, dancers should be of classical ballet or contem-
porary dance modalities, of both sexes, over 18 years of age, paid to dance
(being characterized in this research as professional dancers). In order to
become a professional dancer, it is necessary to have an average profes-
sionalization time of 6.8 ± 5.7 years4. Dancers should belong to dance
companies of the following states: Rio de Janeiro, São Paulo, Minas Gerais
and Rio Grande do Sul. Exclusion criteria included illiterate dancers and
those who were unable to complete the questionnaires adequately.
Dance companies were chosen for convenience, using the regions of
Brazil with the greatest concentration of professional Companies, namely
states of Rio de Janeiro, São Paulo, Minas Gerais and Rio Grande do Sul.
Although there are no agencies that regulate dance companies In Brazil,
pointing to numerical data, these states were selected because they are cur-
rently the poles of professional dance in Brazil. Thirty-six companies were
invited, but only 12 (Sao Paulo - 4, Rio de Janeiro - 4, Minas Gerais - 2,
Rio Grande do Sul - 2) accepted to participate, with percentage of 33.3%.
Those who did not accept claimed lack of time.
For data collection, self-administered questionnaires about Eating
Disorders Symptoms (Eating Attitudes Test; Bulimic Inventory Test
Edinburgh); Yoshitake Fatigue Questionnaire; and general Information
were used, described below:
Eating Disorders Symptoms: Two questionnaires, the Eating Attitude
Test (EAT-26) and Bulimic Inventory Test Edinburgh (BITE) were used.
EAT-2613 was, created to detect symptoms of Anorexia Nervosa, is a
questionnaire composed of 26 questions proposed by Garner13, and has
validation for Brazilians14. Each question has a rating, with a score. For
ordinal-scale responses Never, Almost Never, and Few, score zero points,
at times, often and always scored 1, 2 and 3 points, respectively. Only for
question 25, this sum occurs inversely. After the sum of questions, the
scores of individuals will vary from 0 to 78 points; the cutoff point origi-
nally set by the authors is 21 points13, in which individuals who scored 21
points or more are classified as having symptoms, which means that they
have a risky eating behavior to develop eating disorders. Lower scores are
classified with no symptoms.

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 BITE15 is an instrument used to detect symptoms of Bulimia Nervosa.
It is composed of 33 questions subdivided into 2 scales, which was translated
into Portuguese by Cordás and Hochgraf16. According to the classification
of the authors16, in the first scale of the questionnaire, the degree of the
bulimic symptoms is classified, summing up 30 points. Score greater than
or equal to 20 points means compulsion and high probability of bulimia
diagnosis, 15 to 19 points corresponds to a subclinical group, 10 to 14 points
represents unusual eating pattern and 0 to 9 points is equivalent to the
absence of behavior typical of bulimia. The second scale aims to indicate
severity through the frequency of compulsive and purgative behaviors.
Score less than or equal to 4 indicates level of severity without significance,
from 5 to 9 points clinically significant level and a score greater than 10
indicate signs of high severity. For statistical analysis, in this study, they
were later grouped and classified as: “symptomatic” in absence (“absence
of typical behaviors of bulimia”) and presence (“unusual eating pattern”
+ “subclinical group” + “compulsion and high probability of bulimia di-
agnosis); and “severity” in absence (“without significance”) and presence
(“clinically significant” + “evidence of high severity”).
These two questionnaires are cited as the instruments most widely
used for the evaluation of eating disorders17, and have already been used
in studies conducted with dancers6,18.
Fatigue: evaluated by the Yoshitake Fatigue Questionnaire, validated
for Portuguese by Metzner and Fischer10. The questionnaire consists of 30
multiple choice questions divided into three domains, with 10 questions
each, according to the authors’ classification10: The first one evaluates
drowsiness and lack of disposition at work. The second is about the difficulty
of concentration and attention. The third refers to fatigue projections to the
body. The final score is calculated by summing up the scores of the three
domains, ranging from 30 (lower fatigue) to 150 points (higher fatigue)10.
This questionnaire was chosen because it evaluates fatigue in workers, as
is the case of the study population.
General information: age, sex, schooling, marital status, functional
occupation, presence of diseases, economic stratum, practice of physical
activity in addition to dance and anthropometric variables (body mass and
height to calculate body mass index kg / m 2) for weight status. Since the
questionnaire was answered online, anthropometric variables were self
referenced by participants themselves.
Body Mass Index (BMI) was calculated by means of body mass (in Kg)
divided by height in meters elevated to the square using data self-referenced
by dancers. The use of self-reported measures for the adult population is
satisfactory and is considered a viable alternative in situations where it is
not possible to directly obtain this information19. Dancers were classified
by cutoff points established by WHO - World Health Organization 20, in
which 18.5 kg / m 2 - low weight; between 18.5 and 24.9 kg / m 2 - ideal
weight (eutrophic); between 25 and 29.9 kg / m 2 - overweight and above
30 kg / m 2 - obesity. For statistical analysis, in this study, low weight clas-

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Eating disorders in professional dancers Rodrigues et al.

sification remained the same and ideal and overweight classifications were
grouped into ideal weight, since only one person was overweight and no
one was obese.
Economic stratum was assessed using the questionnaire of the Brazilian
Economic Classification Criteria (CCEB), which is indicated by the Bra-
zilian Association of Research Companies (ABEP)21. It has items related
to the amount of comfort items, access to public services, and schooling
of the family head. Summing up the points of the questions, participants
were divided into A, B1, B2, C1, C2, D and E; to then be classified into:
High (A), Medium (B1, B2, C1, C2), Low (D, E).
The study was approved by the Ethics Research Committee on Human
Beings (CEPSH) of the State University of Santa Catarina (UDESC),
protocol No. 1,152,774, on July 14, 2015, as prescribed in Resolution 466
of the National Health Council. Data collection began on August 2015
and ended on March 2016.
The contact with dance companies was initiated by phone calls, emails
and social networks. The entire process was explained along with the
referral of the questionnaire online link and with the free and informed
consent, in which the dancer had the options “accept to participate” or
“do not accept to participate”. In addition, there was a place to fill with
personal data in case the dancer chose to receive the return of the research.
Questionnaires were applied online through the Google Docs platform,
which is a free web 2.0 tool that is easy to access and has wide visibility22,
thus allowing simultaneous collection in the selected states. According to
Gonçalves23, the application of online questionnaires has several advan-
tages, among them: easy tabulation and data analysis, reduction of errors
in response completion, control in the order of questions and the option
of mandatory filling of the questionnaire.
In some cases, face-to-face collection was necessary at the request of
dance company managers in order to respect the company’s schedule, which
was carried out at the company’s rehearsal site, using the printed question-
naire. It is understood that the ideal would be just a form of collection, but
it was decided to use both in order to reduce the loss of dance companies.
Data were treated by IBM-SPSS, version 20.0, using descriptive
(mean, standard deviation, median, interquartile interval and percentage)
and inferential statistics. For the association of categorical variables (sex,
schooling, marital status, functional occupation, presence of disease, socio-
economic level, modality, state, practice of physical activity), Chi-Square
and Fisher’s Exact tests were used. Subsequently, normality was calculated
using the Kolmogorov Smirnov test, finding normal data for category “dif-
ficulty of concentration and attention” and for the general fatigue score,
and non-normal data for categories “drowsiness and lack of disposition
at work” and “fatigue projections to the body”. Thus, for the comparison
of mean fatigue categories with eating disorders in parametric data, the
T-test was used for independent samples, and the U-Mann Whitney test
was used in non-parametric data.

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 Binary Logistic Regression was used to associate the symptoms of
eating disorders with the fatigue domains, controlling them for the inde-
pendent variables of sample characterization (modality, sex, age, schooling,
marital status, functional occupation, presence of diseases, state, practice of
PA and economic stratum). The Enter method was used to select variables
with 5% significance level.
In this study, subjects were divided into three groups according to the
symptoms of anorexia, bulimia and bulimia severity.

RESULTS
Table 1 shows significant results between sex and symptoms of anorexia
nervosa (p = 0.003) and the symptomatic bulimia scale (p = 0.022), espe-
cially in females, which means that among dancers who had symptoms for
eating disorders, the majority were female. Economic stratum was signifi-
cantly associated with the symptomatic bulimia scale (p = 0.002), in which
the high level presented higher values, which means that dancers who had
symptoms of bulimia, the majority belonged to the high economic stratum.
In Table 2, no significant results were found.
Table 1. Association of the general characteristics of dancers stratified by eating disorders. Brazil, 2016.

Total EAT BITE_SYM BITE_SEV

% (%) (%) (%)
Pres Abs p-value Pres Abs p-value Pres Abs p-value
Sex 0.003** 0.022* 0.485*
Male 44.9 11.8 51.1 25.9 51.2 50.0 42.7
Female 55.1 88.2 48.9 74.1 48.8 50.0 57.3
Schooling 0.871** 0.771** 0.849**
Elementary School 2.8 0.0 3.3 0.0 3.8 3.1 2.7
High School 63.0 70.6 61.1 66.7 61.2 59.4 64.0
Higher Education 34.3 29.4 35.6 33.3 35.0 37.5 33.3
Marital Status 0.792* 0.874* 0.584*
With partner 38.9 41.2 37.8 37.0 38.8 34.4 40.0
Without partner 61.1 58.8 62.2 63.0 61.2 65.6 60.0
Functional Occupation 0.052** 0.179** 0.582**
Student 12.0 29.4 8.4 22.2 8.2 6.7 14.3
Self employed 57.0 52.9 57.8 51.9 58.9 60.0 55.7
Government Employee 12.0 0.0 14.5 14.8 11.0 16.7 10.0
Private Company 19.0 17.6 19.3 11.1 21.9 16.7 20.0
Presence of Disease 0.359** 1.000** 0.580**
Yes 3.9 0.0 4.8 3.7 4.1 6.7 2.8
No 96.1 100 95.2 96.3 95.9 93.3 97.2
Economic Stratum 0.144** 0.002** 0.430**
High 9.3 23.5 6.7 25.9 3.8 84.4 89.3
Medium 88.0 76.5 90.0 70.4 93.8 9.4 9.3
Low 2.8 0.0 3.3 3.7 2.5 6.2 1.3

EAT - Eating Attitudes Test; BITE_SYM - Bulimic Inventory Test Edinburgh symptomatic scale; BITE_SEV - Bulimic Inventory Test Edinburgh

Rev Bras Cineantropom Desempenho Hum 2017, 19(1):96-107 101

Eating disorders in professional dancers Rodrigues et al.

Table 2. Association of variables related to professional dancers stratified by eating disorders. Brazil, 2016.

Total % EAT BITE_SYM BITE_SEV

Pres. Abs. Pres. Abs. Pres. Abs.
p-value p-value p-value
% % % % % %
Modality 0.575** 0.519* 0.970*
Classic Ballet 31.7 25.5 33.1 26.9 33.8 32.3 31.9
Contemporary Dance 68.3 75.6 66.2 73.1 66.2 67.7 68.1
State 0.459** 0.539** 0.411**
São Paulo 52.0 40.0 54.7 42.7 55.8 58.6 50.0
Rio de Janeiro 25.5 40.0 22.1 33.3 22.1 20.7 26.4
Minas Gerais 5.9 6.7 5.8 4.2 6.5 10.3 4.2
Rio Grande do Sul 16.7 13.3 17.4 20.8 15.6 10.3 19.4
Practice of Physical Activity 0.364* 0.545* 0.080*
Yes 63.0 52.9 64.6 57.7 64.4 75.9 57.1
No 37.0 47.1 35.4 42.3 35.6 24.1 42.9
EAT - Food Attitudes Test; BITE_SYM - Bulimic Inventory Test Edinburgh symptomatic scale; BITE_SEV - Bulimic Inventory Test Edinburgh
severity scale; Pres. - presence of symptoms; Abs. - absence of symptoms. % = Relative frequency. * Chi-square ** Fisher’s exact

Dancers presented mean BMI of 21.17 ± 2.04. Most presented ideal

weight. When associated with symptoms of anorexia nervosa, 17.6% of low-
weight dancers presented symptoms and 9.0% presented no symptoms, while
among ideal weight dancers, 82.4% had symptoms and 91.0% presented
no symptoms (p-value 0.378). Associating BMI with the symptomatic
bulimia severity scale among low-weight dancers, 7.4% had symptoms and
11.4% had no symptoms, among normal weight, 92.6% had symptoms and
88.6% had no symptoms (p-value 0.725). When associated with the bulimia
severity scale among low-weight dancers, 9.4% presented symptoms and
10.8% presented no symptoms, while among normal weight, 90.6% had
symptoms and 89.2% had no symptoms (p-value 1.000) (data not shown).
In this study, it was possible to observe that 15.8% of dancers have symp-
toms of anorexia; 25.2% reported symptoms of disorders on the symptomatic
bulimia scale and 29.9% on the bulimia severity scale (data not shown).
Regarding fatigue, 69.00 ± 13.61 dancers, on average, presented general
fatigue, 25.73 ± 4.80 presented difficulty of concentration and attention,
20.63 ± 5.41 presented fatigue projections to the body and 22.64 ± 5.61
presented drowsiness and lack of disposition at work (data not shown).
Table 3 shows significant data for the comparison of fatigue level in the
drowsiness and lack of attention in the work with the symptomatic bulimia
scale (p = 0.015), and in the fatigue projections to the body compared to the
bulimia severity scale domains (p = 0.014). Significant values were found
comparing to the two bulimia scales, both for the difficulty of concentration
and attention domain (p = 0.003 and p = 0.047), respectively, symptoms and
severity, as for the general fatigue score (p = 0.016) for both scales, which
means that fatigue may be related to symptoms of bulimia nervosa, but in
this study, it was not possible to identify if fatigue is related to disorders or if
disorders are related to fatigue. There were no significant results for anorexia.
In the simple model, drowsiness fatigue, difficulty fatigue and general
fatigue were associated with the presence of symptoms of bulimia and fatigue
projections and general fatigue to bulimia on the severity scale. When the model

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was adjusted for all variables of the general sample characterization, only domain
difficulty fatigue (difficulty of concentration and attention) remained associated.
It was observed that dancers with higher scores in this domain were 1.558 (95%
CI = 1.113-2.179) times more likely to present symptoms of bulimia regardless
of dance modality, sex, age, schooling, marital status, functional occupation,
presence of disease, state, practice of PA and economic stratum (Table 4).
Table 3. Comparison between fatigue and eating disorders in professional dancers. Brazil, 2016.

EAT BITE_SYM BITE_SEV

Fatigue Pres. Abs. p Pres. Abs. p Pres. Abs. p
Md(DIQ) Md(DIQ) Md(DIQ) Md(DIQ) Md(DIQ) Md(DIQ)
Drowsiness 0.286* 0.015* 0.114*
26.0(9) 22.0(6) 25.5(5) 22.0(7) 24.0(6) 22.0(8)
M (sd) M (sd)
Projections 0.727* 0.337* 0.014 #
22.0(10) 20.0(7) 20.5(9) 20.0(8) 22.6(6) 19.8(5)
M (sd) M (sd) M (sd) M (sd) M (sd) M (sd)
Difficulty 0.883 #
0.003 #
0.047#
25.5(5) 25.7(5) 28.1(4) 24.9(5) 27.2(5) 25.1(4)
General 0.621# 0.016 # 0.016 #
70.5(16) 68.7(13) 74.5(12) 67.2(13) 73.9(14) 66.9(13)
EAT - Eating Attitudes Test, BITE_SYM - Bulimic Inventory Test Edinburgh symptomatic scale; BITE_SEV - Bulimic Inventory Test Edinburgh
severity scale; Pres. - presence of symptoms; Abs. - absence of symptoms; Md - median; DIQ - interquartile range difference; M - mean;
sd - standard deviation; P - p-value; Drowsiness fatigue - drowsiness and lack of disposition at work; Projection fatigue - projections
of fatigue to the body; Difficulty fatigue - difficulty of concentration and attention; General fatigue - referring to total instrument fatigue
(sum of the three scales).* U-Mann Whitney; # Test - t.

Table 4. Association of symptoms of eating disorders with fatigue domains.

EAT
OR CRUDE OR ADJUSTED
Fatigue (95% CI) p (95% CI) p
Drowsiness 1.037(0.945;1.138) 0.446 0.736(0.538;1.007) 0.055
Difficulty 0.992(0.887;1.108) 0.882 0.966(0.723;1.291) 0.815
Projections 1.030(0.936;1.133) 0.550 1.388(0.974;1.979) 0.070
General 1.010(0.972;1.050) 0.617 - -
BITE_SYM
OR CRUDE OR ADJUSTED
Fatigue (95% CI) p (95% CI) p
Drowsiness 1.096(1.011;1.189) 0.027 1.109(0.775;1.588) 0.570
Difficulty 1.170(1.048;1.307) 0.005 1.558(1.113;2.179) 0.010
Projections 1.046(0.966;1.134) 0.269 - -
General 1.042(1.007;1.078) 0.019 0.903(0.741;1.010) 0.313
BITE_SEV
OR CRUDE OR ADJUSTED
Fatigue (95% CI) p (95% CI) p
Drowsiness 1.070(0.991;1.154) 0.883 - -
Difficulty 1.099(0.999;1.208) 0.051 - -
Projections 1.100(1.016;1.191) 0.019 1.052(0.853;1.297) 0.638
General 1.039(1.006;1.074) 0.020 1.044(0.952;1.146) 0.361
EAT - Eating Attitude Test, BITE_SYM - Bulimic Inventory Test Edinburgh symptomatic scale; BITE_SEV - Bulimic Inventory Test Edinburgh
severity scale; OR = Odds ratio; Drowsiness fatigue - drowsiness and lack of disposition at work; Projection fatigue - projections of fatigue
to the body; Difficulty fatigue - difficulty of concentration and attention; General fatigue - referring to total instrument fatigue (sum of
the three domains). 95% CI - confidence interval; P-value.* Data were adjusted for all sample characterization variables: modality, sex,
age, schooling, marital status, functional occupation, presence of disease, state, practice of PA and economic stratum.

Rev Bras Cineantropom Desempenho Hum 2017, 19(1):96-107 103

Eating disorders in professional dancers Rodrigues et al.

DISCUSSION
The present study aimed to analyze the comparison between fatigue and
eating disorders in professional dancers in Brazil. There were significant
results in the comparison between fatigue and eating disorders symptoms
in the following domains: drowsiness, lack of attention at work, fatigue
projections to the body, difficulty of concentration and attention and gen-
eral fatigue, indicating that eating disorders symptoms can lead to worse
results in these variables.
It was verified that 15.89% of dancers presented symptoms of anorexia,
25.23% symptoms of bulimia on the symptomatic scale and 29.91% symp-
toms of bulimia on the severity scale. It is noteworthy that the occurrence
of eating disorders among females was higher. Since the presence of eating
disorders symptoms has been associated with body image dissatisfaction,
the higher incidence of these symptoms in females is due to the women’s
concern with the body, being more dissatisfied18.
Likewise, there was a greater occurrence of eating disorders symptoms
in dancers with higher economic stratum, confirming a study that identified
that eating disorders symptoms have been associated with higher strata of
the society24. It was verified that access to different information and media
vehicles (television; Internet) provided by higher economic level greatly
influences the standards of beauty and body25, in which the individual
is surrounded by such information, becoming susceptible to achieve the
ideal body at any cost.
The results of this study are concerning, because eating disorders can
damage the health of dancers2 and reduce their performance. However,
there are controversies, because reports have shown that even during the
occurrence of fatigue, there is no reduction in the performance of dancers27.
Similar results are also found in high-performance athletes, showing that
they present greater resistance to high-intensity exercises9. However, fatigue
is a valence difficult to evaluate and can be confused with tiredness. For this
reason, the use of direct measures to evaluate fatigue is now known as the gold
standard28. However, in this study, fatigue was evaluated through indirect
measurements, since making direct evaluations at national level is not feasible.
Even so, dancers perform intermittent training that ends up requiring higher
VO2 max, which can lead to fatigue27. When fatigue is related to training
in dance, it is hypothesized that it may be related to the training period,
since there is intensification in pre-performance periods and competitions,
compromising the physical and mental preparation of dancers4,8.
Comparing eating disorders symptoms and fatigue, significant results
in fatigue in the drowsiness and lack of disposition at work domains were
found, showing that having problems with sleep can increase the level of
fatigue10, which could be justified by the fact that dancers with symptoms
of eating disorders exercise beyond the intense hours of training29, because
in addition to the interest in the perfect technique, they also aim to have
leaner bodies. Thus, with a focus on performance, there is a significant

104
reduction in sleep time because they spend more hours of their day on
training than on rest, thus increasing levels of fatigue and possibly physical
discomfort in their professional activities4,30.
In addition, it was possible to identify that dancers with higher fatigue
levels in difficulty of concentration and attention domains are more likely
to present symptoms of eating disorders, specifically bulimia. It is known
that bulimia is characterized by episodes of high food intake and exces-
sive concern with body, and individuals make use of extreme means to
stop weight gain, such as excessive exercise7. It is possible that individuals
with higher levels of fatigue due to the excessive training characteristic of
professional dancers are more likely to present the disorder, since they end
up having this greater concern with body and feel more need to practice
physical exercises.
With a tired, aching, and malnourished body, the dancer’s health
becomes impaired 2, making it difficult to focus attention on rehearsals,
impairing his or her performance26. Thus, it seems that dancers are a
category with a greater tendency to have symptoms of eating disorders
and a daily fatigue routine. However, this study did not conclude whether
fatigue leads to the development of eating disorders or the inverse, sug-
gesting the performance of new studies to verify the relationship between
these two variables.
This study has some limitations: the reduced number of dance compa-
nies due to lack of interest in participating in the study, the study design,
which does not allow establishing a cause-effect relationship among the
variables investigated and data collection in two ways (online and in person).
However, it is necessary to highlight the advantages of the present
study, such as the fact that it investigated only professional dancers and
addressed a topic still not widely investigated in literature. The results
obtained by this study can help in the knowledge and awareness of danc-
ers, choreographers and / or directors of dance companies, regarding the
importance of maintaining healthy body both to minimize factors detri-
mental to the performance of dancers, such as fatigue, and to maintain
their general health.

CONCLUSION
When comparing fatigue with the presence of eating disorders symptoms,
there was a relationship between fatigue and symptoms of bulimia nervosa.
It was found that higher fatigue scores (difficulty of concentration and atten-
tion) were associated with higher likelihood of having symptoms of bulimia.
A work should be conducted to eradicate the culture that the dancer
must necessary have a lean body. In classical ballet, the pressure for the
ideal body is much greater than in contemporary dance, and this pressure
coupled with poor diet can damage the health of dancers, leaving their
bodies weaker and less resistant to fatigue, since malnourished and fatigued
body is more prone to injuries.

Rev Bras Cineantropom Desempenho Hum 2017, 19(1):96-107 105

Eating disorders in professional dancers Rodrigues et al.

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